AD/HD: An overview

What is AD/HD?

Attention-deficit/ hyperactivity disorder (AD/HD) is a neurobehavioral disorder that affects an estimated 3% to 7% of the school-age population. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), published by the American Psychiatric Association, describes three subtypes of AD/HD:

Inattentive: A child can’t seem to get or stay focused on a task or activity

Hyperactive-impulsive: Very active and often acts without thinking

Combined: Inattentive, impulsive, and too active

How is AD/HD diagnosed?

Currently, there are no medical tests, such as blood tests or electrical imaging (like an MRI), that diagnose AD/HD. However, research in this area is being conducted with the hope that making the diagnosis can be more precise in the near future.

At this time, behavior criteria from DSM-IV are used to make the determination of AD/HD. Some of these behaviors are seen more often at certain periods of child development, and behaviors may vary for boys and girls. Individual clinicians may interpret the criteria differently, so it’s important that you choose a qualified professional to make the diagnosis.

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Because of inconsistencies in diagnosis by medical professionals, the American Academy of Pediatrics (AAP) came out with its guidelines in May 2000. It recommends a comprehensive assessment that relies on direct information from parents (or caregivers) and the classroom teacher (or other school professional) using developmental history, rating scales, observations, and available test results.

Information from all of the sources is reviewed carefully. The clinician has to make a judgment about whether the symptoms of AD/HD impair academic achievement, classroom performance, family and social relationships, independent functioning, self-esteem, leisure activities, and/or self-care. So it usually takes two or more visits to the clinician before a diagnosis can be made.

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Behaviors generally are observed before age 7. Symptoms need to be present in at least two places — for example, at school or home or in a childcare setting — and for at least six months. They should occur more often and be more severe than for other kids of the same age or developmental level.

A few of the symptoms of AD/HD are:

A child doesn’t pay close attention to details

Doesn’t seem to listen when spoken to directly

Is easily distracted

Has difficulty organizing and finishing tasks

Fidgets with hands and feet; has difficulty remaining seated

Runs about or climbs excessively when inappropriate (seems “motor-driven”)

Does things that are dangerous without thinking about possible outcomes

What does this mean for your child?

Kids with AD/HD may be delayed as much as 30% of their actual age in their ability to pay attention and remember. This means that a 9-year-old may act more like a 6-year-old in his ability to focus and use self-control. Imagine how hard it might be for a first grader to sit and concentrate on instruction in a fourth grade classroom, and you’ll get an idea of how hard it is for many kids with AD/HD to function in groups their own age. It doesn’t mean his intelligence is any less; it’s just the ability to control impulses that’s affected.

What services are available?

A medical diagnosis of AD/HD doesn’t automatically qualify your child for special education. Your child must be assessed and found eligible by the public school’s multidisciplinary team in order to qualify for services. If she’s experiencing academic problems along with AD/HD, you or the teacher may request an evaluation to see if she qualifies for special education services.

Kids with AD/HD may be eligible under “specific learning disability” since attention problems may be the cause of significant academic difficulties. Or they may qualify as “emotionally disturbed” if their social or emotional behaviors negatively affect their ability to learn. Or they can be considered “other health impaired” if they have limited strength, vitality, or alertness (including increased attention to environmental stimuli which results in limited concentration in the educational setting) and the AD/HD adversely affects their educational performance.

If your child with AD/HD doesn’t qualify for special education, she may be eligible for accommodations, such as preferential seating, in the general education classroom under Section 504 of the Rehabilitation Act. This law prohibits discrimination on the basis of a disability. She qualifies if the public school’s multidisciplinary 504 team agrees that, in comparison to the average child with no disability, she has an impairment that “substantially limits one or more major life activities.”

If your child doesn’t qualify for these services, then her needs may be addressed in the general education classroom.

How is it treated?

Depending on your child’s needs, more than one of the following may be appropriate and/or necessary to help your child succeed.

Medication

Behavior-management strategies at home and at school

Classroom accommodations

Family and child counseling

How can parents help?

Anticipate problems and help him make a plan.

Establish clear rules, limits, and expectations.

Reduce the amount of talking and reminding; use charts and lists as reminders instead.

Consistently use positive reinforcement and logical consequences.

Collaborate with his teacher about necessary modifications and/or accommodations.

Look for opportunities to support and celebrate his strengths, especially in the non-academic areas.

Become knowledgeable about AD/HD by reading, attending conferences, participating in support groups or online communities.

Depending on your child’s age, discuss the specifics of his AD/HD, using books and websites for kids.

Be sure that childcare providers and leaders of groups and programs outside of school are aware of the management strategies that you and the school have found to be effective.